BJMS Borneo Journal of Medical Sciences ORIGINAL ARTICLE Effects of Alcohol towards Quality of Life in the Indigenous Groups of the West Coast Division, Sabah, Malaysia Asong Joseph1*, Helen Benedict Lasimbang2, Sandi James3, Chua Bee Seok1 ABSTRACT 1 Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia Alcohol consumption has consequences for 2 Department of Reproductive Health, the health and quality of life of individuals and Faculty of Medicine and Health Sciences, communities. It is a problem among some of the Universiti Malaysia Sabah, Indigenous groups of Sabah and Sarawak with Kota Kinabalu, Sabah, Malaysia some of the highest prevalence of risky drinking 3 Faculty of Health, Science and Engineering, in Malaysia. Alcohol is considered to be part of La Trobe University, Victoria, Australia the culture of some of these Indigenous groups and a way to maintain the connection to their culture and traditions. However, drinking too * Corresponding author’s email: much on a single occasion and drinking regularly [email protected] over time is not a part of the culture. Therefore, this study aimed to investigate the positive and Received: 10 October 2019 negative effects of alcohol on quality of life (QoL) of an Indigenous community of Sabah. A Accepted: 10 March 2020 total of 56 villagers from the West Coast Division of Sabah were interviewed in focus group discussions using the diamond dialogue tool. Data were analysed using thematic analysis and revealed that alcohol consumption has both beneficial and adverse effects on health, behavioural, social, economic and psychological factors, depending on the drinking patterns. These harmful results suggest that awareness and harm-reduction programmes may help to empower the Indigenous groups of Sabah to reduce alcohol-related harm. INTRODUCTION Keywords: alcohol consumption, alcohol-related harm, quality of According to the World Health Organization life, Indigenous group, traditional (WHO), alcohol is the world’s third-largest risk alcohol, Diamond Dialogue tool factor fordisease burden1. In 2016, alcohol was reported as representing 132.6 million disability-adjusted life years (DALYs) globally which represented 5.1% of all DALYs in that year1. It is known to cause more than 200 Borneo Journal of Medical Sciences 14 (2) May, 2020: 19 – 30 Borneo Journal of Medical Sciences 14 (2) May, 2020: 19 – 3011 (3): 35 – 38 communicable and non-communicable home-brewed alcohol (such as tapai and diseases and injuries2. In 2011, there were more montoku) and later venture into drinking than 2 billion people worldwide consuming “western-style” beverages such as beer and alcoholic beverages and out of that 76.3 spirits8. Drinking alcohol is known to have million had an alcohol use disorder1. The some benefits such as helping to celebrate harmful use of alcohol caused an estimated 3 and socialize and enhancing the joyfulness million deaths globally in 20161. In the same of ceremonies9. It is also used as part of year, Malaysia was reported to be the tenth social, business, and family life, an enjoyable largest consumer of alcohol in the world3. and habitual accompaniment to food and Sabah is listed as having the third-highest celebrations. However, drinking alcohol to the prevalence of risky drinkers after Kuala Lumpur point of intoxication has not been reported to and Sarawak4. Alcohol is also associated with a be a part of tradition among these Indigenous significant reduction in quality of life, both for groups10. Moreover, according to Asmat individuals and communities1. Quality of life (2018)11, the abuse of alcohol can destroy the is an important parameter that provides an aim of these cultures. This pattern of drinking insight into how a disorder impacts the lives of contributes to serious health consequences2 those affected. and increases the chances of hurting oneself or others due to accidents, violence and suicide1. QoL is defined as a measure of the whole person, including physical and mental health According to Singh (2012)12, alcohol and social well-being1. A healthy QoL is not just consumption in Sabah peaks during the the absence of acute disease or chronic illness Kaamatan month (yearly in May) among but is re-conceived as a positive state of overall Kadazandusun communities. Kaamatan or subjective well-being. This concept involves Pesta Kaamatan is a form of harvest festival the dimensions of biological, psychological, which is celebrated annually by ethnic sociological and economic factors that include Kadazandusun in Sabah, Malaysia. Several a sense of achievement and mastery over activities are held during Kaamatan such as individual goals. It can also be an important cultural dance and music, traditional sports measure in tracking treatment outcomes for and games, carnivals and the grand Unduk alcohol use disorders5. Compromised quality Ngadau, otherwise known as Miss Kaamatan of life has been linked to depression, anxiety (Harvest Festival Queen). During most festivals and alcohol consumption6. According to in Sabah (including Kaamatan. Christmas and McCulloch (2006),6 many people drink alcohol New Year), alcohol prices are controlled by the to help deal with anxiety and depressive Government preventing traders from taking thinking patterns. advantage of the public and profiting by raising the price. Traders who are found not following In Sabah, alcohol is considered to be a the pricing set by the Government are fined. part of traditional culture, especially for some The culture of many Indigenous groups is of the Indigenous groups7. These Indigenous strongly connected to drinking alcohol but communities in Sabah, such as Kadazandusun, does not encourage abuse11. Research has Murut, Sungai and Rungus8, consider alcohol not previously been done looking at the role to be part of everyday life and as a key factor alcohol plays in the QoL of these communities in maintaining the culture and traditions7. A and this study aimed to address this gap in study found that youth in these Indigenous knowledge through exploring the role of groups start drinking at or before 15 years of alcohol in the lives of Indigenous groups from age8. They often start drinking the traditional the Western Division of Sabah. 20 Effects of Alcohol towards Quality of Life in the Indigenous Groups of the West Coast Division, Sabah, Malaysia MATERIALS AND METHODS Materials and Procedure This qualitative study was using focus group The Diamond Dialogue tool by Willetts et al. discussions for the collection of data. The study (2018)14 (Figure 1) was used to identify the was conducted between 2016 and 2017 in impact of alcohol consumption on the health numerous villages in the West Coast Division. and quality of life of the Indigenous groups Communities were purposively selected for included in this study. It has been previously this study and identified as Kadazandusun, used as a research tool to evaluate the being an alcohol-consuming community, effectiveness of interventions in improving and having some awareness of the harms the quality of life in a variety of contexts14. caused by alcohol for their people. Participants Diamond Dialogue: A Tool to Explore Alcohol- included community members aged between related Harm and Strengthen Community 15 and 75. More females than males attended, Action10. The Diamond Dialogue is a diamond- and groups created were gender-specific and shaped tool, used to capture a diverse number of varied ages, with members from each village of perspectives during the discussions (Figure being placed in the same group where possible. 2). A happy face is placed at the top of the diamond representing “perfectly satisfied” Participants and Location and a sad face at the bottom representing “completely dissatisfied” with their sense of the Purposive sampling was applied to select quality of life. The researcher(s) begin by asking hazardous and harmful drinkers among participants about their definition of happiness the indigenous communities of Sabah. and unhappiness: “What does happiness mean As recommended by Babor et al. (2013)13 to you?”, “What does unhappiness mean to hazardous and harmful drinkers are suggested you?”, followed by identifying the factors that for brief education and brief intervention to influence “What makes you happy?”, “What reduce the alcohol related harm. By knowing makes you unhappy?”. Participants were then the impact of drinking style towards alcohol- asked about the effect alcohol has on the related harm would help to develop an quality of life in their community: “What’s appropriate intervention for further study. positive about alcohol?”, “What’s negative Screening by using AUDIT was done to about alcohol?”, “What role does alcohol play select participants who scored between 8 in your culture?”. Participants were also asked to 19 on AUDIT or known as hazardous and to mark on the diamond provided by the harmful drinkers. The data was collected in researcher(s) the happiest they had ever been one community meeting during the ‘Leaders and the saddest they had ever been between United Event of indigenous people of Sabah’ the extremes very happy and very unhappy. at PACOS-Trust located in Penampang, The Diamond Dialogue was used because it Sabah. PACOS-Trust stands for Partnership of was found to be a useful tool to allow each Community Organization. PACOS-Trust is a person to reflect and make their meaning community-based organization dedicated to in their discussion as well as getting rich supporting indigenous